Source / episode info
- **Episode:**660
- **Title:**DIP Ep 660: USMLE Step 2/3 Rapid Review Series 139 (Super HY Stuff)
- **Published:**2026-06-27
- Source:Episode page
One-liner
This episode covers high-yield topics including the pathophysiology and management of DIC following IUFD (with specific lab findings), the diagnosis and prophylactic treatment of Antiphospholipid Syndrome (APS) using low-dose aspirin and LMWH, critical contraindications for TIPS procedures in advanced liver disease, and insulin regimen adjustments during acute illness.
High-yield summary
- IUFD/DIC: Necrotic fetal or placental tissue releases Tissue Factor, initiating the coagulation cascade, leading to consumption coagulopathy (DIC). Key labs include elevated PT/PTT, decreased platelets, increased D-dimer, and critically, reduced fibrinogen.
- APS Diagnosis: Requires positive antibodies (Anti-cardiolipin, Lupus Anticoagulant, Anti-_2 glycoprotein) on two separate occasions, separated by at least 12 weeks.
- APS Management: Prophylaxis involves low-dose aspirin (81 mg) and Low Molecular Weight Heparin (LMWH) throughout pregnancy.
- IUFD Delivery: The preferred method is vaginal delivery (D&E or medical induction with Misoprostol); C-section is generally not recommended due to increased surgical risk without benefit.
- TIPS Contraindications: Absolute contraindications include severe heart failure (low EF), severe pulmonary hypertension ({PA} > 45 { mmHg}), and uncontrolled hepatic encephalopathy/risk of worsening HE.
- Insulin in Illness: In Type 1 Diabetes, if the patient is nauseous or not eating, continue basal insulin (long-acting) but hold mealtime insulin (rapid-acting) to prevent precipitous hypoglycemia while maintaining coverage against counter-regulatory hormone surges.
Learning objectives
- Recognize the pathophysiology and laboratory hallmarks of DIC following IUFD or other thrombotic events.
- Apply prophylactic management strategies for Antiphospholipid Syndrome (APS) in pregnancy using low-dose aspirin and LMWH.
- Identify absolute contraindications to TIPS procedures, specifically relating them to cardiac function and hepatic metabolism.
- Determine appropriate insulin regimen adjustments for Type 1 diabetics experiencing acute illness or poor oral intake.
- Understand the clinical significance of overlapping fetal skull bones on ultrasound in IUFD.